NOTHING BUT THE TOOTH -- Can dental work cause headaches?

By Dr. Richard Greenberg

Friday

Sep 14, 2018 at 4:17 PMSep 14, 2018 at 4:17 PM

Q. Recently, I have been getting a lot of headaches. New for me. Went to the primary doc and he sent me for an MRI. Talked about it to a friend and mentioned that I had been to the dentist and had some work done recently. She said that it might have been the dental work that caused the headaches. Is that possible? -- S.E.

A. I need to ask a few more questions, and yes, it is possible for patients to have what they describe as headaches after dental treatment. It is unusual and I would need to pose some possibilities for why this could happen.

I would first need to know a more-complete history of your head pain. Have you had this kind of pain before? If so, for how long? Was it the same intensity and in the same place? Is there a trigger that you can stimulate to cause it again or change the intensity? Was it similar to the type of head pain you might get from eating something that is extremely cold quickly? In other words, I would need a little more explanation to rule out some of the other more-significant causes of head pain. I would hope that your doctor had taken the time to ask some of these questions prior to referring you for an MRI.

As far as a dental procedure and it alone causing some post treatment head pain, yes, there are a number of reasons that this can happen. The most-common of these relate to upsetting the relationship of your upper and lower jaws and thereby causing muscular stress. During any dental procedure, in order to facilitate your treatment, it is necessary for you to use those muscles to open your mouth. They are activated when you are asked “Open, please." If the dentist or hygienist loses sight of that fact, they may not let you periodically relax and inactivate those muscles. Just like any other muscles in your body, if they are not used to being stretched on a regular basis and are overused, they will react with pain.

Because these muscles are part of your head structures, this can easily be interpreted by you as an average headache. I know that as a dentist, sometimes I get into a lengthy procedure and it becomes very intense. I might lose sight of the fact that you the patient have to work at keeping your mouth open to accommodate my treatment and then your muscles might get overworked. If a general surgeon is operating on you, they do not have to think about things like this, as you usually are sedated or asleep.

With dentistry, most times we as practitioners only control the possibility of pain during the procedure and the rest needs your help and cooperation. We need to let you the patient rest periodically, so that these muscles are not overstressed. If pain occurs after the procedure and you consult the dentist, he or she will probably prescribe some anti-inflammatory medication with or without a muscle relaxant. In 24 to 48 hours, if this was the cause of your head pain, the medications along with your resting the muscles and chewing soft food will usually resolve the problem.

Another possible dental cause for this headache-type pain is the possibility that the relationship of your upper and lower jaws was changed as a result of some dental restoration or filling. As a dentist, the object in treating you is to not upset that relationship, but normal human error can occur. If the dentist released you from treatment with a filling that was too high or too tight between your teeth or not tight enough between your teeth, an alteration of the normal will occur and muscle pain is a possibility. It is critical that the dentist does everything he or she can to eliminate this from happening, but if it does, you have to make the dentist aware that something feels strange in your mouth. Even if this happens after you leave the office, it is important to not neglect it. Yes, it is possible for your muscles to accommodate this change without causing headaches or pain but it should be addressed in every instance.

We as health practitioners try to make no mistakes, but occasionally we do and need you to be comfortable addressing that possibility with a question or concern. Then it will be up to your dentist to evaluate that concern and either rectify it or explain to you why it occurred and whether or not a change needs to be made.

I do realize that patients often think that “the doctor knows best,” but as I said prior, we are human and do make errors and need patient feedback to help us achieve the proper result of our treatment. That proper result is to deliver our care in a kind and pain-free manner with as little post-operative discomfort as possible.

S.E., I hope this has answered your very important question that I believe many patients have unduly endured.

-- Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at dr.richard@nothingbutthetooth.org.